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NEWS: Ray Moynihan Expanding definitions of obesity may harm children BMJ 2006; 332: 1412 [Full text]

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Response to Moynihan

William H. Dietz   (1 July 2006)

Re: Response to Moynihan

William H Dietz   (9 July 2006)

Response to Moynihan 1 July 2006
William H. Dietz, Director, Division of Nutrition and Physical Activity Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MSK-24, Atlanta GA, USA 30341 Send response to journal: Re: Response to Moynihan	To the Editor of the British Medical Journal: I was disappointed at some of Mr. Moynihan’s assertions (1). He wrote that I am “one of the driving forces” behind the deliberations of an expert committee in the United States over whether to call children whose body mass index is > 95th percentile for age and sex “obese” rather than “overweight” and whether to identify children whose BMI is between the 85th and 95th percentiles for age and sex as “overweight” rather than “at risk of overweight,” as they are currently classified. Moynihan’s article stated that I am “a senior member of the drug company funded International Obesity Task Force.” This article is followed by a second article by Moynihan, that suggested that the International Obesity Task Force (IOTF) is a shill for drug companies (2). The juxtaposition of these two articles implies that I am responsible for the committee’s decisions and that furthermore my role is to promote the reclassification so as to promote the use of drug therapy for obese children and adolescents. Moynihan cites concerns raised by two senior scientists regarding the change in terms and suggests that somehow my influence over the expert committee is sufficient to prompt the committee to ignore the consequences that a change in terminology may have. Such a suggestion demeans the integrity, authority, expertise, and sensitivities of the 15 clinical groups and organizations represented on the expert committee, including the American Academy of Pediatrics, the American Academy of Family Practice, the American Academy of Child and Adolescent Psychiatry, the American Dietetic Association, and the National Association of Pediatric Nurse Practitioners. That I declined to comment on concerns raised about the expert panel’s deliberations does not imply some conspiratorial intent. I declined to comment because it was inappropriate for me to do so. Although my employer, the Centers for Disease Control and Prevention (CDC), has provided financial support for the expert committee and its writing groups, as have the American Medical Association and the Health Resources and Services Administration, I am not a member of the committee. Moreover, the committee’s recommendations have not been finalised, and when they are, they will be those of the expert committee, not my recommendations or the CDC’s. A major inaccuracy in Moynihan’s first article is that I am a member of the IOTF; I have not been a member of the IOTF since 2000. During the time that I was a member, I chaired a working group on childhood obesity that developed an international reference population for the classification of childhood overweight and obesity (3). Drug therapy for the pediatric population was not an approach that our working group considered, nor is it one I have ever endorsed as routine therapy for children or adolescents who are overweight or at risk of overweight. For example, an editorial I wrote in 1994 raised concerns about the use of drug therapy in the pediatric age group (4). More recently, we specified that drug therapy be reserved for severely overweight children or adolescents, and then only after the failure of more conservative therapy (5). As we stated in that article, “Until more extensive safety and efficacy data are available, medications for weight loss should be used only on an experimental basis in adolescents and children.”(5,6) The therapies used to treat overweight children have been based, and will continue to be based, on the risks associated with their excess weight, not on the terms used to describe them. 1. Moynihan R. Expanding definitions of obesity may harm children. BMJ 2006;332:1412. (17 June.) 2. Moynihan R. Obesity Task Force linked to WHO takes “millions” from drug firms. BMJ 2006;332:1412. (17 June.) 3. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320:1240-3. (6 May) 4. Dietz WH. Pharmacotherapy for childhood obesity? Maybe for some. Obesity Res 1994;2:54-5. 5. Dietz WH, Robinson TN. Overweight children and adolescents. New Engl J Med 2005;352:2100-9. 6. Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL. Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled clinical trial. Competing interests: None declared
Re: Response to Moynihan 9 July 2006
William H Dietz, Director, Division of Nutrition and Physical Activity CDC, 4770 Buford Hwy NE, MSK-24, Atlanta, GA USA 30341 Send response to journal: Re: Re: Response to Moynihan	In my prior response to moynihan, I neglected to add the following disclosure. The findings and conclusions in this response are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention. Competing interests: None declared